Objective To explore the effectiveness and safety of free fat transplantation in the repair of facial depression deformity. Methods A total of 90 patients with facial depression deformity admitted to our hospital from January 2022 to June 2023 were selected as the research objects. They were divided into control group and observation group by random number table method, with 45 patients in each group. The control group was repaired with traditional silicone material, and the observation group was repaired with free fat. The clinical efficacy, complication rate and plastic satisfaction of the two groups were compared. Results The total effective rate of the observation group was 93.33%, which was higher than 77.78% of the control group (P <0.05). The incidence of complications in the observation group was lower than that in the control group (P <0.05). The satisfaction of the observation group was 80.00%, which was higher than 53.33% of the control group (P <0.05). Conclusion For patients with facial depression deformity, the use of free fat transplantation can improve clinical efficacy, reduce postoperative complications, and improve patient satisfaction, which is worthy of clinical application.